Medical practices & clinics
Books and taxes for plastic surgeons.
Surgical deposits paid months out, financing payouts that land short, implant costs, and reconstructive cases billed to insurance. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
March came in at $66,200. Two financed tummy tucks paid out short of the invoiced price, so I booked the lender's cut as a fee instead of letting it look like a discount.
- CareCredit payoutPatient financing revenue
- Surgical deposit, LindqvistSurgical deposits
- Availity batch depositReconstructive case reimbursements
- Mentor implants orderImplant and device costs
- Surgery center facility feeFacility and OR costs
Why your books are different
A plastic surgery practice's books go wrong around the surgery date, not the payment date.
Money often changes hands months before or after the actual procedure: a deposit to hold the date, a financing payout with a fee taken out, an implant cost passed straight to the patient. A generalist books everything the day it lands and loses the thread between a payment and the case it belongs to.
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1
Surgical deposits arrive before the procedure
A patient booking a rhinoplasty often pays a deposit weeks or months before the surgery date to hold the slot, which can make a quiet consultation month look busy when the actual procedures haven't happened yet.
What we doKeeps surgical deposits in their own line until the procedure happens, so scheduled cases don't get confused with completed ones. -
2
Financed procedures pay out less than invoiced
When a patient finances an $11,000 procedure through CareCredit or a similar company, the payout is the price minus the lender's fee. Booked as the full sale, both your prices and your true costs read wrong.
What we doBooks the full procedure price as money in and the lender's cut as a financing fee, so your pricing and your costs both show up honest. -
3
Implant and device costs get lost in general supplies
Breast implants and similar devices are a direct, traceable cost tied to a specific case, often thousands of dollars each, and lumped in with general medical supplies they disappear into the noise.
What we doKeeps implant and device costs in their own line, tied to the cases they belong to, so the real cost of each procedure type is visible. -
4
Cosmetic and reconstructive cases get blended
A reconstructive case billed to insurance and a cosmetic case paid in cash or financed look nothing alike in margin or timing, and blended together you lose sight of which side is actually driving revenue.
What we doKeeps cosmetic and reconstructive case revenue in separate lines, so each side of the practice shows its real weight.
Your categories
The categories Gus keeps for a plastic surgery practice.
Set up once for how cases get paid, deposited, and financed. You never pick a category. He does, and an accountant checks it.
Money in
- Surgical depositsPayments to hold a surgery date, kept apart until the procedure happens.
- Patient financing revenueThe full procedure price, with the lender's cut booked as its own fee.
- Reconstructive case reimbursementsInsurance deposits for medically necessary reconstructive procedures.
- Cash-pay cosmetic revenueProcedures paid directly without financing or insurance.
- Post-op product salesCompression garments and recovery products sold to patients.
Money out
- Implant and device costsBreast implants and similar devices, tracked by the case they belong to.
- Facility and OR costsAccredited surgery center fees separate from your own professional fee.
- Clinical and surgical staff wagesNurses, surgical techs, and coordinators, kept apart from provider compensation.
- Financing and card processing feesWhat CareCredit, Alphaeon, or a card processor keeps before you get paid.
- Malpractice insuranceAnnual or quarterly premiums, often higher given surgical scope.
- Marketing and consultation costsAdvertising and the consultation process that fills the surgical schedule.
- Rent and utilitiesOffice and consultation space, kept apart from surgery center fees.
What we watch for you
- Deposit balance
How much surgical deposit money is tied to procedures not yet performed.
- Financing cost
What lenders keep on financed procedures, worth knowing before offering it on every consultation.
- Cosmetic versus reconstructive mix
How much of the month came from cash-pay cosmetic work versus insurance-billed reconstructive cases.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things plastic surgeons ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
I keep it as a deposit, not completed revenue, until the procedure actually happens, so a busy consultation month doesn't read as a busy surgery month.
The lender took its fee before paying out. I book the full invoiced amount as revenue and the lender's cut as a cost, so your real price still shows.
They're tracked as the cost of that specific procedure. What to do with the deduction is the accountant's call, but I keep the cost visible and tied to the right case.
The tax side
The tax side of a plastic surgery practice.
Most of what matters here is separating cosmetic from reconstructive revenue and knowing where the pass-through deduction starts to phase out.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- The pass-through deduction phases outA plastic surgery practice can lose part or all of the 20 percent pass-through deduction once taxable income passes $201,750 single or $403,500 joint, since medical practices are a specified service trade.
- Implant and device costsImplants and devices are generally tracked as the cost of the procedure they went into, separate from your other operating expenses, which affects how margin reads on the return.
- Surgical equipment purchasesSurgical and in-office procedure equipment can usually be written off the year you buy it, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Contract or covering surgeonsA surgeon covering your practice occasionally who bills you directly is often a contractor and gets a 1099-NEC if you pay them $2,000 or more in 2026, due January 31.
Deductions plastic surgery practices miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Surgery center facility fees
- Implant and device costs
- Malpractice premiums
- CME courses and travel
- Board certification renewal
- Financing and card processing fees
- Post-op recovery products
- Consultation and marketing costs
- Scrubs and surgical apparel
- Practice management software
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A plastic surgery year, kept every month.
Consultations, deposits, and surgery dates each land on their own timeline. Your taxes run on a fixed one. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Plan the year
Last year's return gets started, and you get a monthly set-aside so April is already handled, even with financed cases still settling.
- April
Filed. Done.
Your return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where you stand, what you will owe, and whether the surgical schedule ran heavier or lighter than planned.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, as consultations for the new year start booking.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for plastic surgery practices. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions plastic surgeons ask first.
Do you handle insurance billing for reconstructive cases?
No. Gus does not handle insurance billing, medical coding, or claims of any kind. Your practice management software or billing service still does that. Gus works from what actually lands in your bank account.
How do you handle a surgery deposit paid months before the procedure?
It stays in its own line as a deposit, not completed revenue, until the procedure happens, so scheduled work doesn't get confused with finished work.
Why does a financed procedure show up as less than what we billed?
The financing company takes a fee before paying out. Gus books the full price as revenue and the fee as a cost, so your real pricing still shows on the books.
Do implant costs count as a deduction the year I buy them?
They're generally tracked as the cost of the specific procedure rather than a general expense. Gus keeps that cost tied to the right case and the accountant handles how it's reported.
How do you separate our cosmetic revenue from reconstructive insurance cases?
By the deposit source itself. Cash and financing payouts go to cosmetic revenue, insurance payer deposits go to reconstructive revenue, kept in separate lines from the start.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
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What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever